| NPI | 1538300355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KS 60670) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA 30425) |
| Enumeration Date | 2009-03-09 |
| Last Update Date | 2021-10-06 |